Paramedic Cory Yeo with the King-American Ambulance company completes paperwork after transporting a patient to UCSF medical center, on Thursday 12, 2014, in San Francisco, Calif. A report by the budget analyst reports the city needs to increase its ambulance staffing, improve its emergency system coordination and 911 dispatch system and replace it's aging ambulance fleet.

The San Francisco Fire Department doesn't have enough paramedics or working ambulances to respond to the city's increasing number of 911 calls - yet the agency has failed to purchase ambulances it has had money to buy since 2012.

The findings from the Board of Supervisors' budget and legislative analyst, released this week, raise questions about the city's ability to respond to emergencies, Supervisor London Breed said. The report found that the Fire Department has been given enough money to buy 16 new ambulances since 2012, but "not even one of these 16 ambulances has been purchased to date."

"We clearly have a lot of work to do," said Breed, who requested the report after an earlier audit found that in 2013, nearly 2,500 people had to wait longer than a reasonable time to be transported to a hospital because an ambulance wasn't immediately available to respond to a 911 medical call.

She noted that last week, the family of a 2-year-old boy crushed by a statue at Fisherman's Wharf waited 13 minutes for an ambulance. The boy later died.

"If these calls are happening eight times a day on average, what happens in the event of an emergency - an earthquake, a terror attack?" Breed said. "I'm very dismayed."

Private ambulances

The city limits the number of private ambulance providers that operate in San Francisco under an exclusive operating agreement with the state that requires the Fire Department to respond to 80 percent of emergency medical calls. But in 2013, that response rate was just 73 percent - down from 98 percent in 2007. During that time, 911 medical calls increased by about 21 percent.

City officials agree that the department needs to improve its response rate or it could risk losing its state deal.

The problem, the budget analyst found, is largely the result of understaffing during the day and an aging fleet of ambulances that break down so frequently that as many as one-third of the vehicles are out of service at any given time.

"The useful life span for an ambulance is about 10 years," said Amanda Guma, the report's author, adding that 53 percent of the agency's current fleet has exceeded that. "Eight ambulances are taken out of service on any given day for repairs."

The mayor has included enough money to hire 16 new medics in next year's budget, the report said, the number the budget analyst believes is needed to reach that 80 percent threshold.

Fire Chief Joanne Hayes-White disagreed that the money was enough to get to 80 percent. She told a supervisors committee Thursday that the department needs $10 million in next year's budget to increase its staffing and shore up its ambulance fleet, but it received only $3 million. That's enough for the 16 new hires plus three new ambulances, but it's short of the 42 employees it had sought.

"It's a step in the right direction," she said. "It won't get us into compliance (with the 80 percent rate), but it will get us closer to where we need to get."

New ambulances

Hayes-White said the department put in a requisition in November to purchase 10 of the 16 ambulances that have been authorized for purchase since 2012, and she expects to receive those vehicles by year's end. An additional nine - including the three included in next year's budget - should be purchased in 2015, Hayes-White said.

She said those ambulances won't increase the fleet size, but will replace some of the 23 ambulances that are beyond their life span.

Hayes-White said it took the department about a year to put in that requisition because officials needed time to figure out what kind of ambulances to purchase.

"That's almost an embarrassment," Breed said.

"I would agree," responded Hayes-White.

But Fire Department Chief Financial Officer Mark Corso said the process will be much quicker in the future because the agency now has a contract with an ambulance provider and will not have to go through the long decision-making or bidding process.

Even with the new hires, the report stated, the department should make structural reforms in the paramedic division to better utilize its workforce.

The department is in part constrained by a voter initiative, pushed by the fire union, that mandates minimum firefighter staffing per station, the report found. The measure requires all fire stations to be open and fully staffed 24 hours a day, meaning the Fire Department cannot reassign staff members from fire suppression to emergency medical response - despite only 27 percent of calls being for fires. The remaining are for medical emergencies.

Waste of time

The new report noted that medics are wasting time cleaning out vehicles or working on administrative duties, but the department could remedy that by increasing its overtime staffing of medics and using civilians to stock and clean ambulances.

Increasing the amount of overtime to cover employees that call in sick would greatly help the department increase its response rates, the report found.

"Currently, an ambulance is staffed by two (medic) employees - if one calls in sick, their partner is assigned to administrative duties at the station, and the ambulance isn't sent out for service," said Guma, the report's author.

Hayes-White, however, said that it is difficult to use overtime to fill in for employees who are sick because of the way paramedic shifts are organized.